title: Patients previously treated for nonfunctioning pituitary macroadenomas have disturbed sleep characteristics, circadian movement rhythm, and subjective sleep quality.
abstract: OBJECTIVE
  Fatigue and excessive sleepiness have been reported after treatment of nonfunctioning pituitary macroadenomas (NFMA). Because these complaints may be caused by disturbed nocturnal sleep, we evaluated objective sleep characteristics in patients treated for NFMA.
  
  
  METHODS
  We conducted a controlled cross-sectional study.
  
  
  METHODS
  We studied 17 patients (8 women; mean age, 54 yr) in remission of NFMA during long-term follow-up (8 yr; range, 1-18 yr) after surgery (n = 17) and additional radiotherapy (n = 5) without comorbidity except for hypopituitarism and 17 controls matched for age, gender, and body mass index. Sleep was assessed by nocturnal polysomnography, sleep and diurnal movement patterns by actigraphy, and quality of life and subjective sleep characteristics by questionnaires.
  
  
  RESULTS
  Compared to controls, patients had reduced sleep efficiency, less rapid eye movement sleep, more N1 sleep, and more awakenings in the absence of excessive apnea or periodic limb movements. Actigraphy revealed a longer sleep duration and profound disturbances in diurnal movement patterns, with more awakenings at night and less activity during the day. Patients scored higher on fatigue and reported impaired quality of life.
  
  
  CONCLUSIONS
  Patients previously treated for NFMA suffer from decreased subjective sleep quality, disturbed distribution of sleep stages, and disturbed circadian movement rhythm. These observations indicate that altered sleep characteristics may be a factor contributing to impaired quality of life and increased fatigue in patients treated for NFMA.
authors.affiliation: Department of Endocrinology and Metabolism, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands. n.r.biermasz@lumc.nl
authors.forename: N R
authors.initials: NR
authors.lastname: Biermasz
authors.forename: S D
authors.initials: SD
authors.lastname: Joustra
authors.forename: E
authors.initials: E
authors.lastname: Donga
authors.forename: A M
authors.initials: AM
authors.lastname: Pereira
authors.forename: N
authors.initials: N
authors.lastname: van Duinen
authors.forename: M
authors.initials: M
authors.lastname: van Dijk
authors.forename: A A
authors.initials: AA
authors.lastname: van der Klaauw
authors.forename: E P M
authors.initials: EP
authors.lastname: Corssmit
authors.forename: G J
authors.initials: GJ
authors.lastname: Lammers
authors.forename: K W
authors.initials: KW
authors.lastname: van Kralingen
authors.forename: J G
authors.initials: JG
authors.lastname: van Dijk
authors.forename: J A
authors.initials: JA
authors.lastname: Romijn
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D001007:Anxiety / Q000523:psychology; D015992:Body Mass Index; D002940:Circadian Rhythm / Q000502:physiology*; D003863:Depression / Q000523:psychology; D006970:Disorders of Excessive Somnolence / Q000209:etiology; D005221:Fatigue / Q000209:etiology; D005260:Female; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000032:analysis / Q000378:metabolism; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology; D009069:Movement Disorders / Q000209:etiology*; D019635:Neurosurgical Procedures; D010911:Pituitary Neoplasms / Q000150:complications* / Q000601:surgery; D017286:Polysomnography; D011788:Quality of Life; D012890:Sleep / Q000502:physiology*; D012893:Sleep Wake Disorders / Q000209:etiology*; D011795:Surveys and Questionnaires
chemical_list: D007334:Insulin-Like Growth Factor I